Many members of the conventional medical establishment, including doctors, researchers, physical therapists, and others, are highly focused on evidence-based treatments for their neck and back pain patients. What this means is they want to see the proof that the therapy or surgery works before they'll use or recommend it.
And to a great extent, this is good. With healthcare the booming industry that it is, scientific evidence is key to treatment that delivers pain relief and improved quality of life. But the potential for over-treatment is decidedly there. Worse, doctors often prescribe treatments that haven't been proven to work in a safe and effective manner for patients —even though they should, and even though patients depend on them to do so.
For example, many doctors prescribe opioids as a first line treatment for even mild cases of spine pain. But this may not always be necessary. A 2016 systematic review and meta-analysis found that most people taking narcotic pain relievers for back pain (also known as opioids) did not get "clinically important pain relief" in the dosage range evaluated. The review/meta-analysis concludes that people who tolerate opioids may get "modest short-term relief" at best and that there's really no evidence to speak of for long-term pain relief.
Just the same, the use of opioid pain relievers is increasing steadily, especially for musculoskeletal disorders. The National Medical Expenditure Panel Survey revealed a 104 percent increase in opioid prescriptions in 2010, and one researcher reports that about half of opioid users have back pain. He comments that the use of opioids for chronic back pain is controversial due to its potential safety and effectiveness issues.
As narcotics, this type of medication comes with a risk for addiction. Before consenting to the prescription or taking the drug, it's best to weigh its potential for addiction as well as other side effects (such as constipation) against pain relief that you could possibly get through other means.
Another hot-button issue in spine treatment is the overuse of diagnostic imaging. Many doctors order a full workup for their patients with back pain—even the mild cases that are likely to resolve on their own.
In a 2009 study entitled, "Overtreating Chronic Back Pain: Time to Back Off?," which was published in the Journal of the American Board of Family Medicine, author Rick Deyo, M.D., PhD., found that even though guidelines for doctors strongly discourage using imaging tests when they are not necessary (mainly because of the resulting unnecessary medical costs), the number of lumbar spine MRIs increased by 307 percent in the 12 years following 1990. The author also notes that the rate of imaging tests given to spine patients varies "dramatically" across the country and that back surgery rates are highest where the imaging rates are also the highest.
Deyo suggests that up to two-thirds of the imaging tests given may be done so inappropriately.
A 2016 study published in the Permanente Journal found that people with public insurance got spine MRIs more frequently than those with either no insurance or private insurance.
Deyo also notes the things that may be driving this upward trend in the use of diagnostic imaging for low back pain: The growth of the imaging sector of the healthcare industry, increases in patient demand for MRIs, "the compelling nature of visual evidence," as Deyo puts it, lawsuit threats, and money.
Back surgery is another area where over-treatment may be rampant. In the same article mentioned above, Deyo says that the rate of spinal fusions performed during the 12-year period increased by 220 percent. The author noted a trend toward more surgery (and of course higher costs) for those patients who got MRIs early on in their course of treatment. The problem is, these surgeries did not, overall, improve patients' pain levels or ability to function, he concludes.
Generally, research recommends trying physical therapy and other conservative treatment for six weeks. If the therapy (and your participation in it) fails to relieve the pain, at that point surgery may be a possibility. But many doctors don't offer their spine patients a prescription to PT. Should this be the case between you and your physician, advocate for yourself by asking for it. And if she tries to push you into back or neck surgery before you're convinced, it may be time to seek a second opinion. Link here to learn more about the causes of pain and how to treat them.